| NPI | 1083322457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANGELO RIVES Manager 804-479-5761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2022-11-14 |